Correlation of invasive methods and urine cytology in detection of urothelial neoplasms: one centre early experience with application of The Paris System for Reporting Urinary Cytology

Česká verzia

Authors: Tomáš Pitra ¹; Marie Dikanová ²; Milan Hora ¹; Michal Michal ^3,4 ; Ondřej Hes ^3,4; Kristýna Pivovarčíková ^3,4
Authors place of work: Urologická klinika LF UK a FN, Plzeň ¹; Západočeská univerzita v Plzni, Fakulta zdravotnických studií, Plzeň ²; Šiklův ústav patologie LF UK a FN, Plzeň ³; Bioptická laboratoř, s. r. o., Plzeň ⁴
Published in the journal: Ces Urol 2018; 22(4): 275-284
Category: Original Articles

Summary

Major statement:

Original study dealing with urine cytology, comparing urine cytology and results of invasive methods in detection of urothelial carcinoma.

Aim:

To evaluate the results and influence of new classification (The Paris System for Reporting Urinary Cytology, 2016) on non-invasive urothelial carcinoma (UC) detection.

Material and methods:

A retrospective review of urine cytology reported from 1/2017 to 12/2017 was performed – 629 cases of urine cytology (from 267 patients) were found. The urine cytology („cytological diagnosis”) was carried out with histological/radiologic/cystoscopic correlation („final diagnosis”), wherever available. The patients with no biopsy/imaging examination/cystoscopy were excluded from the study (because there was no possibility to verify the final diagnosis). Finally, 480 cytological specimens from 208 patients were evaluated. The specimens were divided in 230 complex cytological examinations – according to timeline. Results: Overall sensitivity of urine cytology in UC detection was 47.5% (specificity 92.3%). Sensitivity selective in detection of high-grade UC achieved 73% (specificity 87.1%). In low-grade UC, the sensitivity achieved 32.1%, with specificity 100%. The significant difference in sensitivity was observed between patients with three and more in one timeline collected cytological specimens and patients with only one specimen (in high-grade UC was the sensitivity 92.9% for patients with three and more cytology, compared to 60% for patients with only one specimen). The category of atypical urothelial cells (AUC) occurred with a frequency of 1.3% – UC was detected in all AUC cases subsequently.

Conclusions:

The majority of low-grade UCs is evaluated as negative in the Paris system. Many in urine detected low-grade UCs are classified as suspect for high-grade UC (SHGUC). The category AUC should raise the suspicion of presence of UC every time. We recommend three urine collections for cytological evaluation to be provided on subsequent days in all patients.

KEY WORDS

Atypical urothelial cell, Paris classification, urine cytology, urothelial carcinoma, upper urinary tract.

Zdroje

1. Babjuk M, Burger M, Compérat E, et al. Non‑muscle‑invasive bladder cancer. EAU Guidelines Edn presented at the EAU Annual Congress Copenhagen 2018. Arnhem, The Netherlands: EAU Guidelines Office; 2018.

2. Witjes JA, Bruins M, Compérat E, et al. Muscle‑invasive and metastatic bladder cancer. Arnhem, The Netherlands: EAU Guidelines Office; 2018.

3. Rosenthal DL, Wojcik EM, Kurtycz DFI. The Paris System for Reporting Urinary Cytology. Switzerland Springer; 2016.

4. Pivovarčíková K, Pitra T, Hora M, Švajdler M, Hes O. Aktuální pohled na močovou cytologii: co by měl urolog vědět? Ces Urol. 2018; 22(4): 242-250.

5. Mostofi FK, Sobin LH, Torloni H. International histological classification of tumors. Geneva: World Health Organization; 1973.

6. Moch H, Humphrey PA, Ulbright TM, Reuter VE. WHO classification of tumours of the urinary system and male genital organs. Lyon: IARC; 2016.

7. Blick CG, Nazir SA, Mallett S, et al. Evaluation of diagnostic strategies for bladder cancer using computed tomography (CT) urography, flexible cystoscopy and voided urine cytology: results for 778 patients from a hospital haematuria clinic. BJU Int. 2012; 110(1): 84–94.

8. Koss LG, Deitch D, Ramanathan R, Sherman AB. Diagnostic value of cytology of voided urine. Acta Cytol. 1985; 29(5): 810–816.

9. Raab SS, Grzybicki DM, Vrbin CM, Geisinger KR. Urine cytology discrepancies: frequency, causes, and outcomes. Am J Clin Pathol. 2007; 127(6): 946–953.

10. Bastacky S, Ibrahim S, Wilczynski SP, Murphy WM. The accuracy of urinary cytology in daily practice. Cancer 1999; 87(3): 118–128.

11. Hermansen DK, Badalament RA, Bretton PR, et al. Voided urine flow cytometry in screening high‑risk patients for the presence of bladder cancer. J Occup Med. 1990; 32(9): 894–897.

12. Badalament RA, Kimmel M, Gay H, et al. The sensitivity of flow cytometry compared with conventional cytology in the detection of superficial bladder carcinoma. Cancer 1987; 59(12): 2078–2085.

13. Badalament RA, Hermansen DK, Kimmel M, et al. The sensitivity of bladder wash flow cytometry, bladder wash cytology, and voided cytology in the detection of bladder carcinoma. Cancer 1987; 60(7): 1423–1427.

14. Planz B, Jochims E, Deix T, et al. The role of urinary cytology for detection of bladder cancer. Eur J Surg Oncol. 2005; 31(3): 304–308.

15. Rohilla M, Singh P, Rajwanshi A, et al. Cytohistological correlation of urine cytology in a tertiary centre with application of the Paris system. Cytopathology 2018; doi: 10.1111/cyt.12604. [Epub ahead of print].

16. Tan WS, Sarpong R, Khetrapal P, et al. Does urinary cytology have a role in haematuria investigations? BJU Int. 2018; doi: 10.1111/bju.14459. [Epub ahead of print].

17. Zhang ML, Rosenthal DL, VandenBussche CJ. The cytomorphological features of low‑grade urothelial neoplasms vary by specimen type. Cancer Cytopathol. 2016; 124 (8): 552–564.

18. Chu YC, Han JY, Han HS, Kim JM, Suh JK. Cytologic evaluation of low grade transitional cell carcinoma and instrument artifact in bladder washings. Acta Cytol. 2002; 46(2): 341–348.

19. Keller AK, Jensen JB. Voided urine versus bladder washing cytology for detection of urothelial carcinoma: which is better? Scand J Urol. 2017; 51(4): 290–192.

20. Messer J, Shariat SF, Brien JC, et al. Urinary cytology has a poor performance for predicting invasive or high‑grade upper‑tract urothelial carcinoma. BJU Int. 2011; 108(5): 701–705.

21. Dev HS, Poo S, Armitage J, et al. Investigating upper urinary tract urothelial carcinomas: a single‑centre 10-year experience. World J Urol. 2017; 35(1): 131–138.

22. Zhang ML, Rosenthal DL, VandenBussche CJ. Upper urinary tract washings outperform voided urine specimens to detect upper tract high‑grade urothelial carcinoma. Diagn Cytopathol. 2017; 45(8): 700–704.

23. Zincke H, Aguilo JJ, Farrow GM, Utz DC, Khan AU. Significance of urinary cytology in the early detection of transitional cell cancer of the upper urinary tract. J Urol. 1976; 116(6): 781–783.